Baroreflex activation therapy for the treatment of drug-resistant hypertension: new developments

Abstract

In the past few years, novel accomplishments have been obtained in carotid baroreflex activation therapy (BAT) for the treatment of resistant hypertension. In addition, this field is still evolving with promising results in the reduction of blood pressure and heart rate. This overview addresses the latest developments in BAT for the treatment of drug-resistant hypertension. Although not totally understood considering the working mechanisms of BAT, it appeared to be possible to achieve at least as much efficacy of single-sided as bilateral stimulation. Therefore unlike the first-generation Rheos system, the second-generation Barostim neo operates by unilateral baroreflex activation, using a completely different carotid electrode. Also significant improvements in several cardiac parameters have been shown by BAT in hypertensive patients, which set the basis for further research to evaluate BAT as a therapy for systolic heart failure. Yet important uncertainties need to be clarified to guarantee beneficial effects; hence not all participants seem to respond to BAT.

Figure 1

Barostim neo system consisting of an implantable pulse generator and a unilateral electrode. Programming is performed by a computer system, which connects to the device by wireless telemetry. Figure permission was granted by CVRx, Inc.

Figure 2

The implantable pulse generators of the Rheos system (on the left) and Barostim neo (on the right). Figure permission was granted by CVRx, Inc.

Figure 3

The carotid sinus electrodes of Rheos system (on the right) and Barostim neo (on the left). Figure permission was granted by CVRx, Inc.

Figure 4

Systolic blood pressure values from screening, randomized phase, and long-term follow-up of subjects participating in Pivotal Trial. SBP : systolic blood pressure; BPTru : blood pressure measuring device; SE : standard error (Used from Bakris et al. [26]).